Healthcare Provider Details

I. General information

NPI: 1114024437
Provider Name (Legal Business Name): CHARLES CANDEE WHITNEY III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 GENERAL WASHINGTON MEMORIAL BOULEVARD
WASHINGTON CROSSING PA
18977
US

IV. Provider business mailing address

1121 GENERAL WASHINGTON MEMORIAL BOULEVARD
WASHINGTON CROSSING PA
18977
US

V. Phone/Fax

Practice location:
  • Phone: 215-321-1371
  • Fax: 215-321-1378
Mailing address:
  • Phone: 215-321-1371
  • Fax: 215-321-1378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD048097L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: